Despite mandated primary series, health care personnel still hesitant about COVID-19 vaccine and immunizing children

Abstract

Importance: Healthcare personnel (HCP) are important messengers for promoting vaccines, for both adults and children. Our investigation describes perceptions of fully vaccinated HCP about COVID-19 vaccine for themselves and primary series for their children.

Objective: To determine associations between sociodemographic, employment characteristics and perceptions of COVID-19 vaccines among HCP overall and the subset of HCP with children, who were all mandated to receive a COVID-19 vaccine, in a large US metropolitan region.

Design: Cross-sectional survey of fully vaccinated HCP from a large integrated health system.

Setting: Participants were electronically enrolled within a multi-site NYS healthcare system from December 21, 2021, to January 21, 2022.

Participants: Of 78,000 employees, approximately one-third accessed promotional emails; 6,537 employees started surveys and 4165 completed them. Immunocompromised HCP (self-reported) were excluded.

Exposure(s) (for observational studies): We conducted a survey with measures including demographic variables, employment history, booster status, child vaccination status; vaccine recommendation, confidence, and knowledge.

Main outcome(s) and measures: The primary outcome was COVID-19 vaccine hesitancy for all dose types - primary series or booster doses - among HCP.

Results: Findings from 4,165 completed surveys indicated that almost 17.2 % of all HCP, including administrative and clinical staff, were hesitant or unsure about receiving a COVID-19 vaccine booster, despite the NYS recommendation to do so. Depending on age group, between 20 % and 40 % of HCP were hesitant about having their children vaccinated for COVID-19, regardless of clinical versus non-clinical duties. In multivariable regression analyses, lack of booster dose, unvaccinated children, females, income less than $50,000, and residence in Manhattan remained significantly associated with vaccine hesitancy.

Conclusions and relevance: Despite mandated COVID-19 vaccination, a substantial proportion of HCP remained vaccine hesitant towards adult booster doses and pediatric COVID-19 vaccination. While provider recommendation has been the mainstay of combatting COVID-19 vaccine hesitancy, a gap exists between HCP-despite clinical or administrative status-and the ability to communicate the need for vaccination in a healthcare setting. While previous studies describe the HCP vaccine mandate as a positive force to overcome vaccine hesitancy, we have found that despite a mandate, there is still substantial COVID-19 vaccine hesitancy, misinformation, and reluctance to vaccinate children.

Keywords: Coronavirus disease 2019 (COVID-19); Employee health; Healthcare personnel; Vaccine education; Vaccine hesitancy; Vaccine mandate.

Fig. 1.

HCP knowledge about COVID-19 vaccines (N = 4165)* HCP = Healthcare Personnel *Less than 1 % missing Please print in color.

Fig. 2.

HCP confidence about discussing COVIDE-19 vaccines (N = 4165)* HCP = Healthcare Personnel *Less than 1 % missing Please print in color.

Fig. 3.

HCP recommendations on the importance of COVID-19 vaccines (N = 4165) HCP = Healthcare Personnel *Less than 1 % missing Please print in color.

Fig. 4.

HCP beliefs about COVID-19 vaccine and all vaccines HCP = Healthcare Personnel *Less than 2 % missing.